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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 274405204
Report Date: 02/10/2021
Date Signed: 02/10/2021 02:54:50 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/09/2020 and conducted by Evaluator Elizabeth Berumen
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20201009170014
FACILITY NAME:FERNANDEZ, MARIAFACILITY NUMBER:
274405204
ADMINISTRATOR:FERNANDEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 724-0920
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 0DATE:
02/10/2021
ANNOUNCEDTIME BEGAN:
12:34 PM
MET WITH:Maria FernandezTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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PERSONAL RIGHTS
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Berumen conducted an announced tele-investigation via FaceTime (#831-319-3909) with Licensee, Maria Fernandez. The purpose of today's tele-investigation is to deliver investigation findings.

The investigation into the allegation stated above was conducted by Special Investigator Cari Farquhar. Based on the investigation conducted by Special Investigator, Cari Farquhar, it is concluded that although the allegation noted on this complaint may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. The allegation is UNSUBSTANTIATED. LPA Berumen will forward a copy of today’s report to Licensee, Maria Fernandez via email (Mariafernadez514@yahoo.com). LPA requests that Maria respond to the “read receipt” confirmation email to LPA within 24 hours confirming receipt of today’s report. A Notice of Site Visit will also be forwarded to Maria via email and will be required to be posted near the entrance to the day care for 30 days.

This tele-investigation was conducted in Spanish.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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